Healthcare Provider Details

I. General information

NPI: 1083094700
Provider Name (Legal Business Name): NATASHA GRACIELA MOREJON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 NW 166TH AVE
PEMBROKE PINES FL
33028-1717
US

IV. Provider business mailing address

1968 NW 166TH AVE
PEMBROKE PINES FL
33028-1717
US

V. Phone/Fax

Practice location:
  • Phone: 754-244-9702
  • Fax:
Mailing address:
  • Phone: 754-244-9702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number2685422
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2685422
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2685422
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2685422
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number2685422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: